Pleural Effusion

A pleural effusion is an abnormal collection of fluid around the lung resulting from excess fluid production or decreased absorption or both.

Categories of pleural effusions

Uncomplicated pleural effusion
The pleural effusion contains fluid that is free of serious inflammation or infection. If large enough, an uncomplicated pleural effusion can cause symptoms. However, these pleural effusions rarely cause permanent lung problems.

Complicated pleural effusion
A complicated pleural effusion contains fluid that has significant inflammation or infection. If untreated, complicated pleural effusions may harden to form a constricting ring around the lung. This hardening process, called organization, can permanently impair breathing. To prevent organization, complicated pleural effusions require drainage, usually with a tube placed into the chest.

Some medical professionals categorize as Transudative and Exudative.

The pleural effusion fluid is similar in character to the fluid normally present in the pleural space. Transudative pleural effusions rarely require drainage, unless they are very large. Congestive heart failure is an example of a condition that can cause a transudative pleural effusion.

The pleural effusion fluid has excess protein, blood, or evidence of inflammation or infection. An exudative pleural effusion may require drainage, depending on its size and the severity of inflammation. Causes of exudative pleural effusion include pneumonia and lung cancer.

The type of pleural effusion can only be identified by taking a sample of fluid from the pleural effusion.

Causes for Pleural Effusions
The pleura is a thin membrane that lines the surface of the lungs and the inside of the chest wall outside the lungs. In pleural effusions, fluid accumulates in the space between the layers of pleura. Normally, only teaspoons of watery fluid are present in the pleural space, allowing the lungs to move smoothly within the chest cavity during breathing. Excessive fluid may accumulate because the body does not handle fluid properly

Pleural effusions can result from many medical conditions.

  • Cancer
  • Congestive heart failure
  • End-stage renal disease
  • Liver disease (cirrhosis)
  • Lupus and other autoimmune conditions
  • Nephrotic syndrome
  • Pneumonia
  • Pulmonary embolism
  • Bronchial carcinoma
  • tuberculosis
  • mesothelioma
  • lymphoma

Symptoms of Pleural Effusions
Symptoms of pleural effusions may include

  • Chest pain, especially on breathing in deeply (pleurisy, or pleuritic pain)
  • Cough
  • Fever
  • Shortness of breath
Diagnosing of of Pleural Effusions

  • listening with a stethoscope
  • percussion (tapping on the chest)
  • With a chest X-ray
  • With a CT scan
  • With a Ultrasound

Treatment for Pleural Effusions
Treatment for pleural effusions based on treating the medical condition causing the pleural effusion. But Large, infected, or inflamed pleural effusions require drainage to improve symptoms and prevent complications. 

Remove large amounts of fluid, effectively treating many pleural effusions.

Tube thoracotomy
A small incision is made in the chest wall, and a plastic tube is inserted into the pleural space. Chest tubes are attached to suction and are often kept in place for several days.

An irritating substance is injected through a chest tube, into the pleural space. The substance inflames the pleura and chest wall, which then bind tightly to each other as they heal. Pleurodesis can prevent pleural effusions from recurring, in many cases.

Pleural drain
For pleural effusions that repeatedly recur, a long-term catheter can be inserted through the skin into the pleural space. A person with a pleural catheter can drain the pleural effusion periodically at home.

Pleural decortication
Surgeons can operate inside the pleural space, removing potentially dangerous inflammation and unhealthy tissue. Decortication may be performed using small incisions (thoracoscopy) or a large one (thoracotomy).

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